Provider Demographics
NPI:1700385911
Name:HANNA, WILLIAM TAYLOR LEE (MAT, LAT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:TAYLOR LEE
Last Name:HANNA
Suffix:
Gender:M
Credentials:MAT, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 S DIXIELAND RD APT V104
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1817
Mailing Address - Country:US
Mailing Address - Phone:479-857-9218
Mailing Address - Fax:
Practice Address - Street 1:3000 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3217
Practice Address - Country:US
Practice Address - Phone:479-553-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-03
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT8712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer